Association Between Patient Perception of Surgeons and Color of Scrub Attire

Abstract

This survey study involves asking participants about their opinions on positive and negative character traits of male and female clinicians dressed in 4 different colors of scrub suits.

Research suggests there is an association between a physician’s attire and patient confidence in them, as well as patients’ ability to perceive clinician trustworthiness, intelligence, and empathy, with scrubs garnering favor.^1,2,3,4,5 Despite this, to our knowledge, no data exist on scrub color and physician perception. We examined whether scrub color is associated with the ability to be perceived as a surgeon and the perception of selected clinician character traits.

Methods

An electronic survey was administered from June to July 2019 to patients and visitors aged 18 years or older at the University of North Carolina Medical Center in Chapel Hill. The University of North Carolina institutional review board classified the study as exempt from approval and informed consent due to deidentified data. The survey items were Likert-type scales and presented participants with 4 images each of a male and female clinician in different colored scrubs: light blue, navy blue, green, and black (Figure 1). Participants were asked to identify the male and female they most strongly identified with the profession of a surgeon, and then to rank the most and least knowledgeable, skilled, trustworthy, and caring male and female clinicians (Figure 1). Responses from 113 participants were included in the final analysis. Summary statistics (frequencies, percentages) were used to characterize the distribution of responses among the full sample and stratified by age level. Additionally, Fisher exact tests were used to identify associations between responses related to each character trait and age level (SAS, version 9.4; SAS Institute, Inc). Statistical tests were 2-sided and P < .05 denoted significance.

Figure 1. Identification of Surgeon and Skill Based on Scrub Color.

Identifying a surgeon (A) and the most skilled individual (B) based on scrub color.

Results

Age was the only demographic factor collected (18-30 years; 24 participants, 31-60 years; 60 participants, >61 years; 29 participants). Green was most frequently chosen for surgeons, followed by blue, for both sexes of clinicians (male, green: 51 selections [45.1%]; female, green: 47 [41.6%]). Black scrubs were most commonly identified with each negative characteristic (ranked least of a specific trait) for both male and female models (Figure 2), including being the least knowledgeable (male, 44.3%; female, 40.7%), skilled (male, 40.7%; female, 45.1%), trustworthy (male, 44.3%; female, 54.9%), and caring (male, 55.8%; female, 58.4%). However, we observed an association between selections of least trustworthy models and age group for male models, with green (10 [41.7%]) and blue (7 [29.2%]) most often identified as least trustworthy among respondents aged 18 to 30 years and a similar trend for least caring.

Figure 2. Distribution of Trait Identification.

Negative character trait identification (least knowledgeable, skilled, trustworthy, and caring) based on scrub color worn by male (A) and female (B) clinicians.

The male and female clinicians in blue scrubs were most commonly identified as the most caring (male, blue: 64 selections [56.6%]; female, blue: 55 [48.7%]) across all age groups. A differential distribution was noted for least caring female models by age group with green (10 [41.7%]) most often identified as least caring in the youngest population. The female clinician in blue was also most commonly identified as most trustworthy (44 [38.9%]). Of note, 5 participants verbalized they perceived the green scrubs to be janitorial, and 5 respondents asserted that the black scrubs looked deathlike or like a mortician’s uniform.

Discussion

Given the increasing use of scrubs and the magnitude of expenditures dedicated to them, color choices should be purposeful and data based. In our study, participants most strongly recognized the clinicians in green scrubs as surgeons, indicating scrub color as a potentially valuable identification tool. Additionally, across all participants, black scrubs were most commonly chosen for negative character traits while blue scrubs were most commonly chosen for positive traits. Although rapport depends on both tangible and intangible factors, scrub color is an easily modifiable feature that may be a factor in the clinician-patient relationship, and thus, clinical outcomes.⁶

As this was a novel topic, the aim was to explore the potential association between scrub color and perception that might exist to then garner more rigorous follow-up study. Future efforts would be best suited addressing our limitations, including using a wider variety of physician models, collecting additional demographic information, and employing more rigorous sampling and survey question design.